MEDICARE: MRS. HEATHER KNIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	105225	TX

General Provider Information

NPI Number	:	1790152056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER KNIGHT

Provider Business Mailing Address
First Line	:	6801 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3918
Country	:	US
Telephone Number	:	817-840-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	08/21/2015

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Directions to “ MRS. HEATHER KNIGHT ” Practice Location

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